Intracoronary urokinase as an adjunct to percutaneous transluminal coronary angioplasty in patients with complex coronary narrowings or angioplasty-induced complications
| Autor: | Michael J. Cowley, Germano DiSciascio, Ravinder S. Kohli, Evelyne Goudreau, George W. Vetrovec, Nagui Sabri, Mark Warner, Youssef Chami |
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| Rok vydání: | 1992 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Coronary Disease Coronary thrombosis Angioplasty Internal medicine medicine Humans Thrombolytic Therapy cardiovascular diseases Myocardial infarction Thrombus Angioplasty Balloon Coronary Coronary Artery Bypass Aged Retrospective Studies Urokinase Chi-Square Distribution Unstable angina business.industry Coronary Thrombosis Middle Aged medicine.disease Thrombosis Urokinase-Type Plasminogen Activator Surgery Bypass surgery Cardiology Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | The American journal of cardiology. 69(1) |
| ISSN: | 0002-9149 |
| Popis: | The effectiveness of intracoronary urokinase infusion as an adjunct to percutaneous transluminal coronary angioplasty (PTCA) was studied in 50 patients who underwent angioplasty for complex coronary narrowings or had thromboembolic complications during PTCA (29 [58%] men, 3 [6%] stable and 37 [74%] unstable angina, and 16 [32%] prior coronary bypass surgery). The primary indications for intracoronary urokinase infusion were intracoronary thrombus in 27 patients (54%), distal coronary embolization in 9 (18%), and abrupt reclosure in 14 (28%). Urokinase was infused in a mean (+/- standard deviation) dosage of 399,000 +/- 194,000 IU (range 150,000 to 1,000,000) at an average rate of 5,000 to 20,000 IU/min. Angiographic success was achieved in 43 patients (86%). Complications included the need for urgent bypass surgery in 3 patients, Q-wave myocardial infarction in 2, and non-Q-wave myocardial infarction in 12 (8 of whom had peak creatine kinase less than twice the upper normal limit). The incidence of myocardial infarction was significantly higher in patients with vein grafts (69%) than in those with PTCA of native vessels (14%). Two patients died (1 massive gastrointestinal necrosis 24 hours after angioplasty, and 1 after urgent bypass surgery). Mean (+/- standard deviation) fibrinogen levels were 355 +/- 73 mg/dl before urokinase infusion, and 361 +/- 70, twelve hours afterward. Three patients had local bleeding, but no transfusions were needed. It is concluded that intracoronary urokinase is a safe and effective adjunct to PTCA in patients with associated thrombi and may improve the success rate in angioplasty complicated by thrombus formation. |
| Databáze: | OpenAIRE |
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